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The Sacroiliac Joint Can Be A Pain In The Gut - Page #3
 

Lab Studies:
CBC, CMP, ESR, CRP, TSH, Free T4, Total T3, FSH, LH, and testosterone levels were within normal limits.
Vitamin D Level: 14.3 ng/mL (low).
Anti-tissue transglutaminase immunoglobulin A (Anti-tTG IgA): 16 U/mL (high).

Other Studies:
Case Photo #1 X-ray of the right hip and pelvis: Unremarkable.
Case Photo #2 MRI of the right hip: Patchy marrow edema within the right iliac bone abutting the SI joint consistent with grade 3 BSI.

Consultations:
Given recurrent BSI, further metabolic workup was performed. The ESR, CRP, and TSH levels were within normal limits. Testosterone was in the low-normal range with normal FSH and LH values, which was considered consistent with a relative energy deficiency. Anti-tTG IgA was elevated at 16 U/mL, prompting referral to gastroenterology.

An endoscopy was performed and demonstrated patchy erythema in the duodenum and two small erosions in the gastric body Case Photo #3 . Biopsies were obtained and pathologic evaluation demonstrated moderate villous blunting and increased intraepithelial lymphocytes, findings consistent with celiac disease.

Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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